Farshid Mohammadi

Knee injury and Osteoarthritis Outcome Score (KOOS); reliability and validity in competitive athletes after anterior cruciate ligament reconstruction.

OBJECTIVE To validate the Knee injury and Osteoarthritis Outcome Score (KOOS) for the assessment of competitive athletes with higher level sports activities after anterior cruciate ligament (ACL) reconstruction. METHODS AND MEASURES Fifty-seven athletes (39 males and 18 females; age, 25.6 ± 3.4 years; height, 179.6 ± 7.4 cm; weight, 77.6 ± 9.8 kg) after ACL reconstruction were asked to complete the Persian KOOS and Short Form-36 (SF-36) questionnaires in the test session. To evaluate test-retest reliability, all participants filled out the KOOS and SF-36, 6-8 days after the first visit. The properties of the KOOS in terms of reliability [Intraclass Correlation Coefficient (ICC)], internal consistency (Cronbachs alpha), dimensionality (item-scale correlation) and construct validity (Spearmans rank correlation) were evaluated. RESULTS No floor or ceiling effect was observed. The ICCs (S.E.M.s) of the KOOS subscales were: Pain 0.93 (2.2), Symptoms 0.85 (3.1), Activities of Daily Living 0.91 (2.9), Function in Sport and Recreation 0.75 (2.1) and Knee-related Quality of Life 0.89 (2.6). The Cronbachs alphas of the KOOS subscales were: Pain 0.91, Symptoms 0.75, Activities of Daily Living 0.96, Function in Sport and Recreation 0.86 and Knee-related Quality of Life 0.74. Spearmans rank correlations between the subscales of the KOOS and representative subscales of the SF-36 ranged from 0.40 to 0.79. CONCLUSION This study illustrates the validity and reliability of the KOOS in measuring the functional status and quality of life of athletes after ACL reconstruction. This study further validates the use of the KOOS in highly competitive athletes in research on knee injuries.

Which Aspects of Postural Control Differentiate between Patients with Parkinson’s Disease with and without Freezing of Gait?

This exploratory study aimed to identify which aspects of postural control are able to distinguish between subgroups of patients with Parkinsons disease (PD) and controls. Balance was tested using static and dynamic posturography. Freezers (n = 9), nonfreezers (n = 10), and controls (n = 10) stood on a movable force platform and performed 3 randomly assigned tests: (1) sensory organization test (SOT) to evaluate the effective use of sensory information, (2) motor control test (MCT) to assess automatic postural reactions in response to platform perturbations, and (3) rhythmic weight shift test (RWS) to evaluate the ability to voluntarily move the center of gravity (COG) mediolaterally and anterior-posteriorly (AP). The respective outcome measures were equilibrium and postural strategy scores, response strength and amplitude of weight shift. Patients were in the “on” phase of the medication cycle. In general, freezers performed similarly on SOT and MCT compared to nonfreezers. Freezers showed an intact postural strategy during sensory manipulations and an appropriate response to external perturbations. However, during voluntary weight shifting, freezers showed poorer directional control compared to nonfreezers and controls. This suggests that freezers have adequate automatic postural control and sensory integration abilities in quiet stance, but show specific directional control deficits when weight shifting is voluntary.

Motor Switching and Motor Adaptation Deficits Contribute to Freezing of Gait in Parkinson's Disease

Background. Patients with freezing of gait (FOG) have more difficulty with switching tasks as well as controlling the spatiotemporal parameters of gait than patients without FOG. Objective. To compare the ability of patients with and without FOG to adjust their gait to sudden speed switching and to prolonged walking in asymmetrical conditions. Methods. Gait characteristics of 10 freezers, 12 non-freezers, and 12 controls were collected during tied-belt conditions (3 and 4 km/h), motor switching and reswitching (increase of speed in one belt from 3 to 4 km/h and vice versa), and adaptation (adjustment to asymmetrical gait) and re-adaptation (returning to symmetrical gait) on a split-belt treadmill. Results. Following switching, freezers showed the largest increase of step length asymmetry (P = .001). All groups gradually adapted their gait to asymmetrical conditions, but freezers were slower and demonstrated larger final asymmetry than the other 2 groups (P = .001). After reswitching, freezers again showed the largest step length asymmetry (P = .01). During re-adaptation, both controls and non-freezers reached symmetrical levels, but freezers did not. Interestingly, only immediately after switching did one episode of FOG and one episode of festination occur in 2 different patients. Conclusions. Freezers have more difficulties adapting their gait during both suddenly triggered and continued gait speed asymmetry. The impaired ability of freezers during both switching and reswitching would suggest that they have an adaptive deficit rather than difficulties with asymmetry per se. Future work needs to address whether these adaptation problems can be ameliorated with rehabilitation.

Comparison of functional outcome measures after ACL reconstruction in competitive soccer players: a randomized trial.

BACKGROUND The choice of graft for anterior cruciate ligament (ACL) reconstruction remains controversial. Although many outcome studies comparing bone-patellar tendon-bone and semitendinosus and gracilis tendon grafts have been performed, most have not included tests of functional outcomes that challenge the graft. The objective of the current study was to compare the functional performances of soccer players after ACL reconstruction that was performed with either a bone-patellar tendon-bone or a semitendinosus and gracilis tendon graft. METHODS Forty-two soccer players with unilateral ACL injury were prospectively randomized to a bone-patellar tendon-bone group (BPTB group; twenty-one subjects) or a semitendinosus and gracilis tendon group (STG group; twenty-one subjects) and followed a rehabilitation protocol. At the time of return to sports, the patients were asked to execute strength, hop, and jump tests and the results were compared between the groups. Twenty-one healthy athletes were recruited as the control group to evaluate their performance of the same tests. RESULTS The limbs with the ACL reconstruction in the STG group had greater values for quadriceps torque as well as on the triple-hop, crossover-hop, and jump-landing test (p < 0.01), but the STG and BPTB groups showed similar results in terms of hamstrings peak torque and the results of two other hop tests (p > 0.05). Moreover, the subjects with ACL reconstruction had significantly lower values with regard to quadriceps and hamstrings peak torques and the results of the hop and jump tests compared with the healthy athletes (p < 0.01). CONCLUSIONS At the time of return to sports, the STG group had better performance in terms of quadriceps strength and the results of the triple-hop, crossover-hop, and jump-landing tests compared with the BPTB group. Compared with controls, soccer players who had undergone ACL reconstruction had less quadriceps and hamstrings strength and inferior hop performance and jump-landing strategy.

Effect of forward shoulder posture on pulmonary capacities of women

Posture is usually defined as the relative arrangement of the parts of the body. Normal or standard posture is the state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity. Forward shoulder posture (FSP) or “rounded shoulders” is one of the numerous deviations from the normal posture. Kendall et al 1 describes FSP as abduction and elevation of the scapula and a forward position of the shoulders. In addition to abducted scapula, FSP also include winging of the scapula and medial rotation of the humerus.2 The aetiology of FSP has been attributed to several factors. Kendall et al 1 state that posture and relative alignment of body segments are affected by muscle shortening and weakness. They describe FSP as the result of the shoulders being pulled by shortened or tight anterior shoulder girdle muscles, such as the serratus anterior, pectoralis major and minor, upper trapezius and intercostalis muscles. Additionally, FSP may be caused by weakness and lengthening of the muscles that function to pull the scapula toward the spine, such as rhomboids and the middle and lower trapezius muscles.3 4 According to Knudsen,5 FSP can be attributed to the presence of excessive and habitual flexion of the back, which will eventually cause the pectoral muscles to shorten and fix the shoulders in this forward position. Muscle length changes in FSP may result in abnormal scapulohumeral rhythm, impingement of rotator cuff tendons,6 acromioclavicular joint degeneration, bicipital tendonitis3 and painful trigger areas.7 Normal quiet …

Validation of the Persian version of Functional Index Questionnaire (FIQ) and Modified FIQ in patients with patellofemoral pain syndrome

The aim of this investigation was to culturally translate and validate the Functional Index Questionnaire (FIQ) and Modified FIQ (MFIQ) in patients with patellofemoral pain syndrome (PFPS). A sample of 100 patients with PFPS completed the FIQ and MFIQ, and Short-Form 36 (SF-36) Health Survey in the first session. The FIQ and MFIQ were re-administered to a sample of 47 patients to evaluate test–retest reliability. Test–retest reliability and internal consistency were evaluated by the intraclass correlation coefficient (ICC) and Cronbachs alpha coefficient, respectively. Corrected item-total correlations and construct validity were assessed by Spearmans rank correlation. Factor analysis was performed on all items of the Persian FIQ and MFIQ to determine the number of underlying factors and the items which load on each factor. An acceptable level of test–retest reliability (ICC = 0.84, 0.85) and internal consistency (Cronbachs alpha = 0.79, 0.82) was obtained for both the Persian FIQ and MFIQ, respectively. Item-total correlations were greater than 0.40 for all but two questions of the Persian FIQ and all but four questions of the Persian MFIQ. A total of two factors were detected for each questionnaire. There were moderate to low correlations between the Persian FIQ/MFIQ and SF-36. Persian FIQ and MFIQ are two reliable and valid outcome measures of functional limitation and it seems that they are suitable for use in clinical practice of patients with chronic PFPS.

Military Exercises, Knee and Ankle Joint Position Sense, and Injury in Male Conscripts: A Pilot Study

CONTEXT The high incidence of lower limb injuries associated with physical exercises in military conscripts suggests that fatigue may be a risk factor for injuries. Researchers have hypothesized that lower limb injuries may be related to altered ankle and knee joint position sense (JPS) due to fatigue. OBJECTIVE To evaluate if military exercises could alter JPS and to examine the possible relation of JPS to future lower extremity injuries in military service. DESIGN Cohort study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 50 male conscripts (age = 21.4 ± 2.3 years, height = 174.5 ± 6.4 cm, mass = 73.1 ± 6.3 kg) from a unique military base were recruited randomly. main outcome measure(s): Participants performed 8 weeks of physical activities at the beginning of a military course. In the first part of the study, we instructed participants to recognize predetermined positions before and after military exercises so we could examine the effects of military exercise on JPS. The averages of the absolute error and the variable error of 3 trials were recorded. We collected data on the frequency of lower extremity injuries over 8 weeks. Next, the participants were divided into 2 groups: injured and uninjured. Separate 2 × 2 × 2 (group-by-time-by-joint) mixed-model analyses of variance were used to determine main effects and interactions of these factors for each JPS measure. In the second part of the study, we examined whether the effects of fatigue on JPS were related to the development of injury during an 8-week training program. We calculated Hedges effect sizes for JPS changes postexercise in each group and compared change scores between groups. RESULTS We found group-by-time interactions for all JPS variables (F range = 2.86-4.05, P < .01). All participants showed increases in JPS errors postexercise (P < .01), but the injured group had greater changes for all the variables (P < .01). CONCLUSIONS Military conscripts who sustained lower extremity injuries during an 8-week military exercise program had greater loss of JPS acuity than conscripts who did not sustain injuries. The changes in JPS found after 1 bout of exercise may have predictive ability for future musculoskeletal injuries.

Intra- and Inter-session Reliability of Static and Dynamic Postural Control in Participants with and without Patellofemoral Pain Syndrome

PURPOSE To determine the intra- and inter-session reliability of balance performance in people with patellofemoral pain syndrome (PFPS) and matched controls. METHODS In this methodological study, single-leg-stance performance of 15 participants with unilateral PFPS and 15 healthy matched controls was assessed using the Biodex Balance System (BBS) under 4 task difficulty levels (static and dynamic, with and without visual feedback). Intra-class correlation coefficients (ICCs), standard errors of measurement, and coefficients of variation were calculated for the overall stability index, anterior-posterior stability index, and medial-lateral stability index. RESULTS Static and dynamic postural performance during single-leg stance showed moderate to very high reliability in the PFPS group (ICCs=0.53-0.96) and in healthy control participants (ICCs=0.51-0.91). Both measures were more reliable with eyes closed than with eyes open. CONCLUSION BBS stability indices appear to have acceptable reliability in people with PFPS, particularly in more challenging conditions, and may be incorporated into the evaluation and rehabilitation of this patient group.